Fix conversion factor confusion with a QPP check

by: Julia Kyles, CPC Dec 15, 2025

You know that your provider’s conversion factor will be based on their participation in an advanced alternative payment model (APM). Effective Jan. 1, 2026, qualifying participants (QP) will receive a higher conversion factor than non-QPs (PBN blog, 10/31/25).

But you’re not alone if you don’t know how to confirm a provider's advanced alternative payment model particpation status. That information will tell you the conversion factors for their physician fee schedule and anesthesia services in 2026 and beyond.

During the CPT & RBRVS 2026 Annual Symposium, Emily Yoder, CMS deputy director, explained that a QP is a provider who meets “certain thresholds for participation in an advanced APM.” During a follow-up question-and-answer session, attendees asked how a practice or a vendor such as a billing company can check the provider’s status.

The quickest way is through the CMS Quality Payment Program participation look up tool, explained Lindsey Baldwin, director with CMS. Anyone who has a provider’s national provider identifier (NPI) can check an individual provider's participation status. You’ll need to log in to the site if you want to check a group’s status.

The screenshot below shows the 2024 participation results for a physician. (Note: we removed their identifying information.)

In 2026, APM-eligible clinicians will receive a conversion factor of $33.5675 compared to a non-APM conversion factor of $33.4009. For anesthesia conversion factors, the APM-eligible rate will be $20.5998 vs. $20.3178 for non-APMs.

Blog Tags: CMS, conversion factor, Quality payment program

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